Overtreatment of Prostate Cancer Increasing in Men With Short Life Expectancy
WEDNESDAY, Nov. 13, 2024 -- In the active surveillance era, overtreatment of men with limited life expectancy (LE) decreased for those with low-risk prostate cancer, but increased for those with intermediate-risk and high-risk disease from 2000 to 2019, according to a study published online Nov. 11 in JAMA Internal Medicine.
Timothy J. Daskivich, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues examined if rates of overtreatment of men with limited LE have persisted in the active surveillance era and whether overtreatment varies by tumor risk or treatment type. The analysis included 243,928 men with clinically localized prostate cancer diagnosed in the Veterans Affairs (VA) health system from 2000 through 2019.
The researchers found that among men with an LE <10 years, the proportion of men treated with definitive treatment (surgery or radiotherapy, 78 percent) for low-risk disease decreased from 37.4 percent in 2000 to 14.7 percent in 2019. Over time, there were increases for intermediate-risk disease (37.6 to 59.8 percent), which were observed for favorable (32.8 to 57.8 percent) and unfavorable (46.1 to 65.2 percent) intermediate-risk disease. Among men with an LE <10 years, use of radiotherapy increased from 31.3 to 44.9 percent for intermediate-risk disease over time, with increases occurring for both favorable and unfavorable intermediate-risk disease. Among men with an LE less than five years, the proportion of men treated with definitive treatment for high-risk disease increased (17.3 to 46.5 percent), including for radiotherapy specifically (16.3 to 39.0 percent).
"The study results suggest that despite a marked reduction in overtreatment of low-risk prostate cancer in the VA in association with adoption of active surveillance, clinicians should also avoid definitive treatment of men with limited LE to prevent unnecessary toxic effects in men with insufficient longevity to benefit from treatment," the authors write.
One author disclosed ties to the pharmaceutical industry.
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